Liver Cirrhosis Nursing Care Plans

7/27/2019 Liver Cirrhosis Nursing Care Plans

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Liver Cirrhosis Nursing Care Plans

Definition

Cirrhosis is a chronic disease of the liver characterized by alteration in structure, degenerative

changes and widespread destruction of hepatic cells, impairing cellular function and impeding

blood flow through the liver. Causes include malnutrition, inflammation (bacterial or viral), andpoisons (e.g., alcohol, carbon tetrachloride, acetaminophen). Cirrhosis is the fourth leading

cause of death in the United States among people ages 35 to 55 and represents a serious

threat to long-term health.Diagnostic Studies

Liver scans/biopsy :Detects fatty infiltrates, fibrosis, destruction of hepatic tissues, tumors

(primary or metastatic), associated ascites.

Percutaneous transhepatic cholangiog raphy (PTHC):May be done to rule

out/differentiate causes of jaundice or to perform liver biopsy.

Esophagogastro duod enoscopy (EGD):May demonstrate presence of esophageal varices,

stomach irritation or ulceration, duodenal ulceration or bleeding.

Percutaneous transhepatic por tal angiography (PTPA):Visualizes portal venous system

circulation.

Serum bil i rubin:Elevated because of cellular disruption, inability of liver to conjugate, or

biliary obstruction.

Liver enzymes:

AST/ALT, LDH, and isoenzymes (LDH5): Increased because of cellular damage and release

of enzymes.

Alkaline phosphatase (ALP) and isoenzyme (LAP1): Elevated because of reduced excretion.

Gamma glutamyl transpeptidase (GTT):Elevated.

Serum albumin:Decreased because of depressed synthesis.

Globul ins (IgA and IgG):Increased synthesis. CBC:Hb/Hct and RBCs may be decreased because of bleeding. RBC destruction and

anemia is seen with hypersplenism and iron deficiency. Leukopenia may be present as a

result of hypersplenism.

PT/activated partial thromb opl astin tim e (aPTT):Prolonged (decreased synthesis of

prothrombin)

Fibrinogen:Decreased.

BUN:Elevation indicates breakdown of blood/protein.

Serum ammonia:Elevated because of inability to convert ammonia to urea.

Serum glucose:Hypoglycemia suggests impaired glycogenesis.

Electrolytes:Hypokalemia may reflect increased aldosterone, although various imbalances

may occur. Hypocalcemia may occur because of impaired absorption of vitamin D. Nutrient studies:Deficiency of vitamins A, B12, C, K; folic acid, and iron may be noted.

Urine urobi l inogen:May/may not be present. Serves as guide for differentiating liver

disease, hemolytic disease, and biliary obstruction.

Fecal urobi l in ogen:Decreased.Nursing Priorities

1. Maintain adequate nutrition.

2. Prevent complications.


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3. Enhance self-concept, acceptance of situation.

4. Provide information about disease process/prognosis, potential complications, and treatment

needs.

Discharge Goals

1. Nutritional intake adequate for individual needs.

2. Complications prevented/minimized.

3. Dealing effectively with current reality.

4. Disease process, prognosis, potential complications, and therapeutic regimen understood.

5. Plan in place to meet needs after discharge.

Nursing Care Plans

Below are 8 Nursing Care Plan (NCP) for liver cirrhosis.Imbalanced Nutrition

Nursing Diagnosis: Nutrition: imbalanced, less than body requirements

May be related to

Inadequate diet; inability to process/digest nutrients Anorexia, nausea/vomiting, indigestion, early satiety (ascites)

Abnormal bowel function

Possibly evidenced by

Weight loss

Changes in bowel sounds and function

Poor muscle tone/wasting

Imbalances in nutritional studies

Desired Outcomes

Demonstrate progressive weight gain toward goal with patient-appropriate normalization oflaboratory values.

Experience no further signs of malnutrition.

Nursing Interventions Rationale

Measure dietary intake by calorie

count.

Provides information about intake,

needs/deficiencies.

Weigh as indicated. Compare

changes in fluid status, recent weighthistory, skinfold measurements.

It may be difficult to use weight as a direct indicator

of nutritional status in view of edema/ascites.Skinfold measurements are useful in assessing

changes in muscle mass and subcutaneous fat

reserves.

Assist/encourage patient to eat;

explain reasons for the types of diet.

Improved nutrition/diet is vital to recovery. Patient

may eat better if family is involved and preferred


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Feed patient if tiring easily, or have

SO assist patient. Consider

preferences in food choices.

foods are included as much as possible.

Encourage patient to eat allmeals/supplementary feedings. Patient may pick at food or eat only a few bitesbecause of loss of interest in food or because of

nausea, generalized weakness, malaise.

Recommend/provide small, frequent

meals.

Poor tolerance to larger meals may be due to

increased intra-abdominal pressure/ascites.

Provide salt substitutes, if allowed;

avoid those containing ammonium.

Salt substitutes enhance the flavor of food and aid

in increasing appetite; ammonia potentiates risk of

encephalopathy.

Restrict intake of caffeine, gas-

producing or spicy and excessively

hot or cold foods.

Aids in reducing gastric irritation/diarrhea and

abdominal discomfort that may impair oral

intake/digestion.

Suggest soft foods, avoiding

roughage if indicated.

Hemorrhage from esophageal varices may occur in

advanced cirrhosis.

Encourage frequent mouth care,

especially before meals.

Patient is prone to sore and/or bleeding gums and

bad taste in mouth, which contributes to anorexia.

Promote undisturbed rest periods,

especially before meals.

Conserving energy reduces metabolic demands on

the liver and promotes cellular regeneration.

Recommend cessation of smoking. Reduces excessive gastric stimulation and risk of

irritation/bleeding.

Monitor laboratory studies, e.g.,

serum glucose, prealbumin/albumin,

total protein, ammonia.

Glucose may be decreased because of impaired

glycogenesis, depleted glycogen stores, or

inadequate intake. Protein may be low because ofimpaired metabolism, decreased hepatic synthesis,

or loss into peritoneal cavity (ascites). Elevation of

ammonia level may require restriction of protein

intake to prevent serious complications.


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Maintain NPO status when indicated. Initially, GI rest may be required in acutely ill

patients to reduce demands on the liver and

production of ammonia/urea in the GI tract.

Consult with dietitian to provide dietthat is high in calories and simple

carbohydrates, low in fat, and

moderate to high in protein; limit

sodium and fluid as necessary.

Provide liquid supplements as

indicated.

High-calorie foods are desired inasmuch as patientintake is usually limited. Carbohydrates supply

readily available energy. Fats are poorly absorbed

because of liver dysfunction and may contribute to

abdominal discomfort. Proteins are needed to

improve serum protein levels to reduce edema and

to promote liver cell regeneration.Note: Protein and

foods high in ammonia (e.g., gelatin) are restricted if

ammonia level is elevated or if patient has clinical

signs of hepatic encephalopathy. In addition, these

individuals may tolerate vegetable protein better

than meat protein.

Provide tube feedings, TPN, lipids if

indicated.

May be required to supplement diet or to provide

nutrients when patient is too nauseated or anorexic

to eat or when esophageal varices interfere with

oral intake.

Excess Fluid Volume

NURSING DIAGNOSIS: Fluid Volume excess

May be related to Compromised regulatory mechanism (e.g., syndrome of inappropriate antidiuretic hormone

[SIADH], decreased plasma proteins, malnutrition)

Excess sodium/fluid intake


Edema, anasarca, weight gain

Intake greater than output, oliguria, changes in urine specific gravity

Dyspnea, adventitious breath sounds, pleural effusion

BP changes, altered CVP

JVD, positive hepatojugular reflex Altered electrolyte levels

Change in mental status

Desired Outcomes

Demonstrate stabilized fluid volume, with balanced I&O, stable weight, vital signs within

patients normal range, and absence of edema.


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Measure I & O, noting positive

balance (intake in excess of

output). Weigh daily, and notegain more than 0.5 kg/day.

Reflects circulating volume status, developing/resolution

of fluid shifts, and response to therapy. Positive

balance/weight gain often reflects continuing fluidretention. Note: Decreased circulating volume (fluid shifts)

may directly affect renal function/urine output, resulting in

hepatorenal syndrome.

Monitor BP (and CVP if

available). Note

JVD/abdominal vein distension.

BP elevations are usually associated with fluid volume

excess but may not occur because of fluid shifts out of

the vascular space. Distension of external jugular and

abdominal veins is associated with vascular congestion.

Assess respiratory status,noting increased respiratory

rate, dyspnea.

Indicative of pulmonary congestion/edema.

Auscultate lungs, noting

diminished/absent breath

sounds and developing

adventitious sounds (e.g.,

crackles).

Increasing pulmonary congestion may result in

consolidation, impaired gas exchange, and complications,

e.g., pulmonary edema.

Monitor for cardiacdysrhythmias. Auscultate heart

sounds, noting development of

S3/S4 gallop rhythm.

May be caused by HF, decreased coronary arterialperfusion, and electrolyte imbalance.

Assess degree of

peripheral/dependent edema.

Fluids shift into tissues as a result of sodium and water

retention, decreased albumin, and increased antidiuretic

hormone (ADH).

Measure abdominal girth. Reflects accumulation of fluid (ascites) resulting from

loss of plasma proteins/fluid into peritoneal

space. Note:Excessive fluid accumulation can reduce

circulating volume, creating a deficit (signs of

dehydration).

Encourage bedrest when May promote recumbency-induced diuresis.


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ascites is present.

Provide frequent mouth care;

occasional ice chips (if NPO).

Decreases sensation of thirst.

Monitor serum albumin and

electrolytes (particularly

potassium and sodium).

Decreased serum albumin affects plasma colloid osmotic

pressure, resulting in edema formation. Reduced renal

blood flow accompanied by elevated ADH and

aldosterone levels and the use of diuretics (to reduce total

body water) may cause various electrolyte

shifts/imbalances.

Monitor serial chest x-rays. Vascular congestion, pulmonary edema, and pleural

effusions frequently occur.

Restrict sodium and fluids as

indicated.

Sodium may be restricted to minimize fluid retention in

extravascular spaces. Fluid restriction may be necessary

to correct/prevent dilutional hyponatremia.

Administer salt-free

albumin/plasma expanders as

indicated.

Albumin may be used to increase the colloid osmotic

pressure in the vascular compartment (pulling fluid into

vascular space), thereby increasing effective circulating

volume and decreasing formation of ascites.

Administer medications as

indicated:Diuretics, e.g.,

spironolactone (Aldactone),

furosemide (Lasix);

Potassium;

Positive inotropic drugs andarterial vasodilators.

Used with caution to control edema and ascites, block

effect of aldosterone, and increase water excretion while

sparing potassium when conservative therapy with

bedrest and sodium restriction does not alleviate

problem.Serum and cellular potassium are usually

depleted because of liver disease and urinary losses.

Given to increase cardiac output/improve renal blood flowand function, thereby reducing excess fluid.

Impaired Skin Integrity

NURSING DIAGNOSIS: Skin Integrity, risk for impaired

Risk factors may include

Altered circulation/metabolic state

Accumulation of bile salts in skin

Poor skin turgor, skeletal prominence, presence of edema, ascites


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Desired Outcomes

Maintain skin integrity.

Identify individual risk factors and demonstrate behaviors/techniques to prevent skin

breakdown.


Inspect skin surfaces/pressure points

routinely. Gently massage bony prominences

or areas of continued stress. Use emollient

lotions; limit use of soap for bathing.

Edematous tissues are more prone to

breakdown and to the formation of

decubitus. Ascites may stretch the skin to

the point of tearing in severe cirrhosis.

Encourage/assist with repositioning on a

regular schedule, while in bed/chair, and

active/passive ROM exercises as

appropriate.

Repositioning reduces pressure on

edematous tissues to improve circulation.

Exercises enhance circulation and

improve/maintain joint mobility.

Recommend elevating lower extremities. Enhances venous return and reduces

edema formation in extremities.

Keep linens dry and free of winkles. Moisture aggravates pruritus and

increases risk of skin breakdown.

Suggest clipping fingernails short; provide

mittens/gloves if indicated.

Prevents patient from inadvertently injuring

the skin, especially while sleeping.

Encourage/provide perineal care following

urination and bowel movement.

Prevents skin excoriation breakdown from

bile salts.

Use alternating pressure mattress, egg-crate

mattress, waterbed, sheepskins, as indicated.

Reduces dermal pressure, increases

circulation, and diminishes risk of tissue

ischemia/breakdown.

Apply calamine lotion, provide baking soda

baths. Administer medications such ascholestyramine (Questran), hydroxyzine

(Atarax), diphenhydramine (Benadryl),

ifindicated.

May be soothing/provide relief of itching

associated with jaundice, bile salts in skin.

Ineffective Breathing Pattern


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NURSING DIAGNOSIS: Breathing Pattern, risk for ineffective


Intra-abdominal fluid collection (ascites)

Decreased lung expansion, accumulated secretions

Decreased energy, fatigue

Desired Outcomes

Maintain effective respiratory pattern; be free of dyspnea and cyanosis, with ABGs and vital

capacity within acceptable range.


Monitor respiratory rate,

depth, and effort.

Rapid shallow respirations/dyspnea may be present

because of hypoxia and/or fluid accumulation in abdomen.

Auscultate breath sounds,

noting crackles, wheezes,

rhonchi.

Indicates developing complications (e.g., presence of

adventitious sounds reflects accumulation of

fluid/secretions; absent/diminished sounds suggest

atelectasis), increasing risk of infection.

Investigate changes in level

of consciousness.

Changes in mentation may reflect hypoxemia and

respiratory failure, which often accompany hepatic coma.

Keep head of bed elevated.

Position on sides.

Facilitates breathing by reducing pressure on the

diaphragm, and minimizes risk of aspiration of secretions.

Encourage frequent

repositioning and deep-

breathing exercises/coughing

as appropriate.

Aids in lung expansion and mobilizing secretions.

Monitor temperature. Note

presence of chills, increased

coughing, changes in

color/character of sputum.

Indicative of onset of infection, e.g., pneumonia.

Monitor serial ABGs, pulse

oximetry, vital capacity

measurements, chest x-rays.

Reveals changes in respiratory status, developing

pulmonary complications.

Provide supplemental O2 as May be necessary to treat/prevent hypoxia. If


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indicated. respirations/oxygenation inadequate, mechanical ventilation

may be required.

Demonstrate/assist with

respiratory adjuncts, e.g.,incentive spirometer.

Reduces incidence of atelectasis, enhances mobilization of

secretions.

Prepare for/assist with acute

care procedures,

e.g.:Paracentesis;

Peritoneovenous shunt.

Occasionally done to remove ascites fluid to relieve

abdominal pressure when respiratory embarrassment is not

corrected by other measures.Surgical implant of a catheter

to return accumulated fluid in the abdominal cavity to

systemic circulation via the vena cava; provides long-term

relief of ascites and improvement in respiratory function.

Risk for Injury

NURSING DIAGNOSIS: Injury, risk for [hemorrhage]


Abnormal blood profile; altered clotting factors (decreased production of prothrombin,

fibrinogen, and factors VIII, IX, and X; impaired vitamin K absorption; and release of

thromboplastin)

Portal hypertension, development of esophageal varices

Desired Outcomes

Maintain homestasis with absence of bleeding

Demonstrate behaviors to reduce risk of bleeding.


Assess for signs/symptoms of GI

bleeding; e.g., check all secretions

for frank or occult blood. Observe

color and consistency of stools, NG

drainage, or vomitus.

The GI tract (esopahgus and rectum) is the most

usual source of bleeding because of its mucosal

fragility and alterations in hemostasis associated

with cirrhosis.

Observe for presence of petechiae,

ecchymosis, bleeding from one or

more sites.

Subacute disseminated intravascular coagulation

(DIC) may develop secondary to altered clotting

factors.

Monitor pulse, BP (and CVP if

available).

An increased pulse with decreased BP and CVP

can indicate loss of circulating blood volume,

requiring further evaluation.


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Note changes in mentation/level of

consciousness.

Changes may indicate decreased cerebral

perfusion secondary to hypovolemia, hypoxemia.

Avoid rectal temperature; be gentle

with GI tube insertions.

Rectal and esophageal vessels are most

vulnerable to rupture.

Encourage use of soft toothbrush,

electric razor, avoiding straining for

stool, forceful nose blowing, and so

forth.

In the presence of clotting factor disturbances,

minimal trauma can cause mucosal bleeding.

Use small needles for injections.

Apply pressure to small

bleeding/venipuncture sites for longer

than usual.

Minimizes damage to tissues, reducing risk of

bleeding/hematoma.

Recommend avoidance of aspirin-

containing products.

Prolongs coagulation, potentiating risk of

hemorrhage.

Monitor Hb/Hct and clotting factors. Indicators of anemia, active bleeding, or impending

complications (e.g., DIC).

Administer medications as

indicated:Supplemental vitamins

(e.g., vitamins K, D, and C);

Stool softeners.

Promotes prothrombin synthesis and coagulation if

liver is functional. Vitamin C deficiencies increase

susceptibility of GI system to

irritation/bleeding.Prevents straining for stool with

resultant increase in intra-abdominal pressure and

risk of vascular rupture/hemorrhage.

Provide gastric lavage with room

temperature/cool saline solution or

water as indicated.

In presence of acute bleeding, evacuation of blood

from GI tract reduces ammonia production and risk

of hepatic encephalopathy.

Assist with insertion/maintenance ofGI/esophageal tube (e.g.,

Sengstaken-Blakemore tube).

Temporarily controls bleeding of esophagealvarices when control by other means (e.g., lavage)

and hemodynamic stability cannot be achieved.

Prepare for surgical procedures, e.g.,

direct ligation (banding) or varices,

esophagogastric resection,

May be needed to control active hemorrhage or to

decrease portal and collateral blood vessel


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splenorenal-portacaval anastomosis. pressure to minimize risk of recurrence of bleeding.

Risk for Acute Confusion

NURSING DIAGNOSIS: Confusion, risk for acute


Alcohol abuse

Inability of liver to detoxify certain enzymes/drugs

Desired Outcomes

Maintain usual level of mentation/reality orientation.

Initiate behaviors/lifestyle changes to prevent or minimize recurrence of problem.


Observe for changes in behavior

and mentation, e.g., lethargy,

confusion, drowsiness,

slowing/slurring of speech, and

irritability (may be intermittent).

Arouse patient at intervals as

indicated.

Ongoing assessment of behavior and mental status

is important because of fluctuating nature of

impending hepatic coma.

Review current medication

regimen/schedules.

Adverse drug reactions or interactions (e.g.,

cimetidine plus antacids) may potentiate/exacerbate

confusion.

Evaluate sleep/rest schedule. Difficulty falling/staying asleep leads to sleep

deprivation, resulting in diminished cognition and

lethargy.

Note development/presence of

asterixis, fetor hepaticus, seizure

activity.

Suggests elevating serum ammonia levels;

increased risk of progression to encephalopathy.

Consult with SO about patientsusual behavior and mentation.

Provides baseline for comparison of current status.

Have patient write name periodically

and keep this record for comparison.

Report deterioration of ability. Have

patient do simple arithmetic

Easy test of neurological status and muscle

coordination.


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computations.

Reorient to time, place, person as

needed.

Assists in maintaining reality orientation, reducing

confusion/anxiety.

Maintain a pleasant, quiet

environment and approach in a

slow, calm manner. Encourage

uninterrupted rest periods.

Reduces excessive stimulation/sensory overload,

promotes relaxation, and may enhance coping.

Provide continuity of care. If

possible, assign same nurse over a

period of time.

Familiarity provides reassurance, aids in reducing

anxiety, and provides a more accurate

documentation of subtle changes.

Reduce provocative stimuli,confrontation. Refrain from forcing

activities. Assess potential for

violent behavior.

Avoids triggering agitated, violent responses;promotes patient safety.

Discuss current situation, future

expectation.

Patient/SO may be reassured that intellectual (as

well as emotional) function may improve as liver

involvement resolves.

Maintain bedrest, assist with self-

care activities.

Reduces metabolic demands on liver, prevents

fatigue, and promotes healing, lowering risk of

ammonia buildup.

Identify/provide safety needs, e.g.,

supervision during smoking, bed in

low position, side rails up and pad if

necessary. Provide close

supervision.

Reduces risk of injury when confusion, seizures, or

violent behavior occurs.

Investigate temperature elevations.Monitor for signs of infection. Infection may precipitate hepatic encephalopathycaused by tissue catabolism and release of nitrogen.

Recommend avoidance of narcotics

or sedatives, antianxiety agents, and

limiting/restricting use of

medications metabolized by the

Certain drugs are toxic to the liver, whereas other

drugs may not be metabolized because of cirrhosis,

causing cumulative effects that affect mentation,

mask signs of developing encephalopathy, or


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liver. precipitate coma.

Eliminate or restrict protein in diet.

Provide glucose supplements,

adequate hydration.

Ammonia (product of the breakdown of protein in the

GI tract) is responsible for mental changes in hepatic

encephalopathy. Dietary changes may result inconstipation,which also increases bacterial action

and formation of ammonia. Glucose provides a

source of energy, reducing need for protein

catabolism. Note: Vegetable protein may be better

tolerated than meat protein.

Assist with procedures as indicated,

e.g., dialysis, plasmapheresis, or

extracorporeal liver perfusion.

May be used to reduce serum ammonia levels if

encephalopathy develops/other measures are not

successful.

Disturbed Body Image/Self-Esteem

NURSING DIAGNOSIS: Self-Esteem/Body Image disturbed

May be related to

Biophysical changes/altered physical appearance

Uncertainty of prognosis, changes in role function

Personal vulnerability

Self-destructive behavior (alcohol-induced disease)


Verbalization of change/restriction in lifestyle

Fear of rejection or reaction by others

Negative feelings about body/abilities

Feelings of helplessness, hopelessness, or powerlessness

Desired Outcomes

Verbalize understanding of changes and acceptance of self in the present situation.

Identify feelings and methods for coping with negative perception of self.


Discuss situation/encourage

verbalization of fears and concerns.

Explain relationship between nature

of disease and symptoms.

Patient is very sensitive to body changes and may

also experience feelings of guilt when cause is

related to alcohol (70%) or other drug use.

Support and encourage patient; Caregivers sometimes allow judgmental feelings to


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provide care with a positive, friendly

attitude.

affect the care of patient and need to make every

effort to help patient feel valued as a person.

Encourage family/SO to verbalize

feelings, visit freely/participate incare.

Family members may feel guilty about patients

condition and may be fearful of impending death.They need nonjudgmental emotional support and

free access to patient. Participation in care helps

them feel useful and promotes trust between staff,

patient, and SO.

Assist patient/SO to cope with

change in appearance; suggest

clothing that does not emphasize

altered appearance, e.g., use of red,

blue, or black clothing.

Patient may present unattractive appearance as a

result of jaundice, ascites, ecchymotic areas.

Providing support can enhance self-esteem and

promote patient sense of control.

Refer to support services, e.g.,

counselors, psychiatric resources,

social service, clergy, and/or alcohol

treatment program.

Increased vulnerability/concerns associated with

this illness may require services of additional

professional resources.

Knowledge Deficit

NURSING DIAGNOSIS: Knowledge Deficit

May be related to

Lack of exposure/recall; information misinterpretation

Unfamiliarity with information resources


Questions; request for information, statement of misconception

Inaccurate follow-through of instructions/development of preventable complications

Desired Outcomes

Verbalize understanding of disease process/prognosis, potential complications.

Correlate symptoms with causative factors.

Identify/initiate necessary lifestyle changes and participate in care.


Review disease process/prognosis and future

expectations.

Provides knowledge base from which

patient can make informed choices.


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Stress importance of avoiding alcohol. Give

information about community services

available to aid in alcohol rehabilitation if

indicated.

Alcohol is the leading cause in the

development of cirrhosis.

Inform patient of altered effects of medications

with cirrhosis and the importance of using only

drugs prescribed or cleared by a healthcare

provider who is familiar with patients history.

Some drugs are hepatotoxic (especially

narcotics, sedatives, and hypnotics). In

addition, the damaged liver has a

decreased ability to metabolize all drugs,

potentiating cumulative effect and/or

aggravation of bleeding tendencies.

Review procedure for maintaining function of

peritoneovenous shunt when present.

Insertion of a Denver shunt requires

patient to periodically pump the chamber

to maintain patency of the device. Patients

with a LeVeen shunt may wear an

abdominal binder and/or engage in a

Valsalva maneuver to maintain shunt

function.

Assist patient identifying support person(s). Because of length of recovery, potential

for relapses, and slow convalescence,

support systems are extremely important

in maintaining behavior modifications.

Emphasize the importance of good nutrition.

Recommend avoidance of high-protein/salty

foods, onions, and strong cheeses. Provide

written dietary instructions.

Proper dietary maintenance and

avoidance of foods high in sodium and

protein aid in remission of symptoms and

help prevent ammonia buildup and further

liver damage. Written instructions are

helpful for patient to refer to at home.

Stress necessity of follow-up care and

adherence to therapeutic regimen.

Chronic nature of disease has potential

for life-threatening complications.

Provides opportunity for evaluation of

effectiveness of regimen, including

patency of shunt if used.

Discuss sodium and salt substitute restrictions

and necessity of reading labels on food and

Minimizes ascites and edema formation.

Overuse of substitutes may result in other

electrolyte imbalances. Food,


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OTC drugs. OTC/personal care products (e.g.,

antacids, some mouthwashes) may

contain sodium or alcohol.

Encourage scheduling activities with adequaterest periods. Adequate rest decreases metabolicdemands on the body and increases

energy available for tissue regeneration.

Promote diversional activities that are

enjoyable to patient.

Prevents boredom and minimizes anxiety

and depression.

Recommend avoidance of persons with

infections, especially URI.

Decreased resistance, altered nutritional

status, and immune response (e.g.,

leukopenia may occur with splenomegaly)

potentiate risk of infection.

Identify environmental dangers, e.g., carbon

tetrachloridetype cleaning agents, exposure

to hepatitis.

Can precipitate recurrence.

Instruct patient/SO of signs/symptoms that

warrant notification of healthcare provider,

e.g., increased abdominal girth; rapid weight

loss/gain; increased peripheral edema;

increased dyspnea, fever; blood in stool orurine; excess bleeding of any kind; jaundice.

Prompt reporting of symptoms reduces

risk of further hepatic damage and

provides opportunity to treat complications

before they become life-threatening.

Instruct SO to notify healthcare providers of

any confusion, untidiness, night wandering,

tremors, or personality change.

Changes (reflecting deterioration) may be

more apparent to SO, although insidious

changes may be noted by others with less

frequent contact with patient.

Other Nursing Diagnoses

Fatiguedecreased metabolic energy production, states of discomfort, altered body

chemistry (e.g., changes in liver function, effect on target organs, alcohol withdrawal).

Nutrition: imbalanced, less than body requirementsinadequate diet; inability to

process/digest nutrients; anorexia, nausea/vomiting, indigestion, early satiety (ascites);

abnormal bowel function.

Therapeutic Regimen: risk for ineffective managementperceived benefit, social support

deficit, economic difficulties.


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Family Processes, dysfunctional: alcoholismabuse of alcohol, resistance to treatment,

inadequate coping/lack of problem-solving skills, addictive personality/codependency.

Caregiver Role Strain, risk foraddiction or codependency, family dysfunction before

caregiving situation, presence of situational stressors, such as economic vulnerability,

hospitalization, changes in employment.

Liver Cirrhosis Nursing Care Plans

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